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ELECTRICAL.INSPECTOR RECOBD <br />Rev.08-07-2015 <br />DATE ID/SIG.COMMENTSAPPROVALS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Nrleter Release <br />Rouqh <br />Service [Meter <br />F!NAL <br />Notes, Remarks, Etc. <br />A.x <br />I hcrcby aflrnr undcr pcnalty of per.jury that I an cxcnrpl froD lhc C:on(GctoN' liccnse bw for thc followint Een (Soc.7031.5 <br />Busincss aM Prolcssion Codc): Any City or County which rcquircs a pcrmit to construct, ollcr. irnprovc. dem)lish or rcpair my <br />struclure, prior to ils issuance. also rcquircs thc applicail for such fEnrrit to filc a sigrcd slalcmnl lhd ha or slE is lice[Ed pur$ilt <br />to thc provisions of th!' Contractor's l,icenscd law (Chaptcr 9. Commcncing with Scclion TUXJ of Division J of thc Business and <br />Professious Code) or thrr lE or she is ctcmli therefron aod tlE b6is fbr th€ alleged exery{ion. Any violatioo ofsetioD 7031.5 by sry <br />.pplicdntlorapeilnitsubject$the.pplicantloacivilp.naltyofnotmorethanllvchundrcddollars($5uJ). <br />_1. as owner ol lhc profEny. or nry cmployces wilh wages as (hcir solc cornpensalion, willdo thc wtrk and thc structwe is not <br />intcrxlcd or offercd for sle (S6.7(N4. Business and Pnrfcssions Codc: The Contractot's Liccn* ljw d€s not apply lo m owner of <br />the pR4rny wlxr builds or inrproves tlrrBnr, ud wlrc does such work himselt or lErslf or through his oa her own enDloyecs, <br />providcd that such impi()vcrrcnts dc nol intcndcd rlr ollcrcd tor slc. Il: howcvq. thc building or improvcmnt is mb within onc yca <br />ofcorqrlcli)[ llE Owrcr Builler will have tlr burdcn ofprcving lhat h. or she did mt boil,l or imprcve thc prepdty for th. purpoc of <br />stL). <br />_1, ru owner ofthe prr)peny, ilm exclusively conlracting with licensed conlractors lo conslruct lhc prcjcct (Sec. 7044. Busincss <br />arrl hofe\siilCode:ThcCotrtrlc()r'sLicenseLawdNsnotapplytosnownerofprolrnywkrbuildsorimprovesthereon. <br />and who contracts for such proiccts with a Contracbr(s) liccnscd pursuilt to thc Contractor's Licensc Law). <br />-l <br />anlexempt ulder Section-, B. & P.C. tbr tlils reasoo. <br />WORKER!' COMPENSATION <br />D&qI.ABAIIQN <br />I hcrcby aftirm under penalty ofpcrjury onc ofthc lbllowing decltrations: <br />_l havc atrd will nEiorai! a Cenilicate of Conscnt to S.lf-lnsure for workas' mmpcnsation, as prcvid.d for by Scction 3?00 of thc <br />tabo. Codc, for thc perfofl)ffic of lhc work lbr which thc pcrtril is issucd. <br />_l havc atrd will nraintain workers' coDrpc[salion insurance, as requircd by Selion 3700 of lhc tibor Codc, for thc fErfomwc of <br />thc work tbr which this is coicr uxl <br />v€v{ <br />Policy C)qt <br />_l ccnili thal iD lhc lErf()rnuncc ol'thc work for which (his Frmil is issucd, I shall not cnrploy any lrcrson in any manncr <br />s astobccorrcsubjcct(othcworkcrs'cornlrcnsationlawsofcrlifomia.andagreethatiflshouldbccorrcsubjccltothc <br />uukers' con4EnsrtioD proviliotrs of S€ction l7U) of lhe Labor Code, I slull, fo(hwilh corply with thos provisious.. <br />WARNING: Failurc to securc workcrs'compensation covcraee is unlawful, md shall subjccl an employcr to rirninal pcilics and <br />civil tincs !p k) oue lrutrdred thousand dollars (S100,000). in additiur compcnsation. danugcs o providcd fi)r the <br />::^T :kY;Z inlercst and a(torrcy's fces. <br />I hercby affrnr under Fnalry of perjury that I anr liccn*J under prcvision ofChrptcr 9 (cotrrnrcocing with Scction 7fi)0) of Division 3 <br />ol the Business nnd ltoltssi(nrs Code. arxl mv liccnse rs in lull torce and elfect.J €1€ <br />LiceDsc ) <br />>c7 <br />W <br />I hcrcby alfirm undcr F-nalty ol pcrjury (hd there is a conslruction lcnding agercy for the pcrformarce of the work lor which this pcrmit i\ <br />issuctl (Scc. 3097. Civ. C.). <br />kndcr's Name:- <br />[rndcr's Address: <br />AIEUEANLDEELABdI!qN <br />I lmhy allimr undcr pcnalty ol pc{ury onc o[ thc litllowing dcrluations: <br />Dcnx)litioo Pcrnits-Astf,'stos Notification f'cdcral Rcgulations (Titlc 40, Pd6) <br />_Rcquircd txtrcr of Noliication <br />_l cc(ili thal lhc ltdcral rcSulations rcguding utrcskrs rcrmvalsc not applicablc to this projcrcl. <br />_l cc(ili lhat I luvc rcad thir application {xl stalc lhal llrc abovc inlo'nHlion is corcct. I agre lo ontply with all City ilnd Coulty <br />ordinanccs and Statc [is's rclalin8 k) buildiog hcrcby authorizc reprcsntativcs o[this Cily md County to ent6 upon thc <br />abovc nEnlioned propc(y for inspcclion <br />Apllicant or A8$l <br />l'cmrilcc tranrc <br />b/>o